Improving cure rates of B-cell acute lymphoblastic leukemia with chimeric antigen receptor T-cells

Chimeric antigen receptor T cell (CAR T) therapy was first approved for the treatment of children and young adults with relapsed/refractory (R/R) acute lymphoblastic leukemia (ALL). Since then, two additional CAR T products have been approved for adult R/R B-ALL. Through clinical trials and real-world evidence, we have learned that CAR T therapies generally lead to high upfront response rates with usually deep remissions, negative for measurable residual disease (MRD). Despite that, many patients eventually relapse, prompting a need for better prognostication and techniques to prolong remissions and maximize cures. Here, we focus our review on previously known and recently discovered prognostic factors for sustained remissions, and potential avenues for improved cure rates with CAR T therapy for ALL. Lastly, we comment on the importance of removing barriers to accessing CAR T cells for patients with ALL.